(427) Treating hepatitis C in a substance use disorder prenatal clinic: can telemedicine make us better?

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: To assess the impact of infectious disease (ID) telemedicine consultation on hepatitis C (HCV) treatment in a substance use disorder (SUD) prenatal clinic.

Study Design: We performed a retrospective cohort study of all patients in a SUD prenatal clinic from June 2018-June 2022. Telemedicine consults for HCV began March 2020, and included electronic chart review with recommendations from ID when patients were unable to be seen. We compared pre- and post-telemedicine cohorts for rates of screening, testing, and referral to ID for HCV treatment. We then performed a subgroup analysis of patients with positive viral loads (+VL) to determine if telemedicine ID consultation improved attendance at follow up and treatment rate.

Results: 198 patients were included, with 71 in the pre- and 127 in the post-telemedicine groups. A majority in each group were screened for HCV (95.8%, 100.0%), underwent diagnostic viral RNA testing (97.4%, 100.0%), and were referred to ID for treatment (93.1%, 91.7%) when clinically appropriate (Figure 1). Patients with +VL were similar in both cohorts (N= 29, N=36), with a majority unemployed, single, and publicly insured (Table 1). Most reported a history of overdose (64%, 63.5%) and injection use (81.5%, 78.1%), with significantly less heroin use in the post-telemedicine cohort (89.7% vs 61.1%, p=0.02), consistent with national trends. After implementation of telemedicine consult, patients were significantly more likely to attend the ID visit (17.2% vs 41.7%, p=0.03) and receive treatment (13.8% vs 55.6%, p=0.04). Of the total attended visits in the post-telemedicine cohort, 68.8% were telemedicine. 4 patients who missed visits received treatment from obstetrics after ID chart review.

Conclusion: The availability of telemedicine ID consult increased follow up and treatment of HCV, and enabled obstetric providers to directly prescribe HCV treatment when patients were unable to attend follow up. As maternal HCV is rising in prevalence, this represents an area for possible intervention.

Primary & Presenting Author(s)

Cassandra Trammel, MBA, MD (she/her/hers)
Fellow
Washington University in St.Louis
St. Louis, Missouri, United States

Coauthor(s)

LM
Laura R. Marks, MD, PhD
Washington University School of Medicine
St. Louis, Missouri, United States
Shannon E. Beermann, MD
Resident Physician
Washington University School of Medicine
St. Louis, Missouri, United States
MM
Melissa Mills, N/A
Washington University in St.Louis
St. Louis, Missouri, United States
Nandini Raghuraman, MD,MSc (she/her/hers)
Assistant Professor
Barnes Jewish Hospital, Washington University in St Louis
St. Louis, Missouri, United States
Ebony B. Carter, MD, MPH (she/her/hers)
Associate Professor, MFM; Chief, Division of Clinical Resarch
Washington University School of Medicine
St. Louis, Missouri, United States
Anthony O. Odibo, MD
Professor
Washington University School of Medicine
St. Louis, Missouri, United States
AZ
Amanda C. Zofkie, MD
Washington University School of Medicine
St. Louis, Missouri, United States
JK
Jeannie C. Kelly, MD,FACOG,MS
Associate Professor
Washington University School of Medicine
St. Louis, Missouri, United States